Frequency of Hypocalcaemia in Patients with Chronic Kidney Disease
DOI:
https://doi.org/10.70749/ijbr.v3i5.2930Keywords:
Hypocalcemia, Chronic Kidney Disease, Frequency, Pakistan, Prevalence, Tertiary Care.Abstract
Background: Hypocalcemia is a frequent complication in chronic kidney disease (CKD) due to impaired vitamin D activation, phosphate retention, and secondary hyperparathyroidism, contributing to CKD-mineral and bone disorder (CKD-MBD). Limited data exist on its prevalence in Pakistani CKD populations. Objective: To determine the frequency of hypocalcemia and its associations in non-dialysis CKD stages 3–5 patients at a tertiary care hospital in Pakistan. Methods: This cross-sectional study was conducted at the Department of Medicine, Ayub Teaching Hospital, Abbottabad, from June 25, 2024, to January 7, 2025. A total of 188 adult patients with CKD stages 3–5 (eGFR <60 mL/min/1.73 m² for ≥3 months, per KDIGO criteria) were enrolled using convenience sampling. Hypocalcemia was defined as corrected serum calcium <8.5 mg/dL. Data on demographics, clinical characteristics, and biochemical parameters were collected. Statistical analysis was performed using SPSS version 26.0, with chi-square tests, t-tests, and multivariable logistic regression (p<0.05 significant). Results: The mean age was 53.4 ± 13.0 years; 61.7% were male. CKD distribution: stage 3 (26.6%), stage 4 (37.2%), stage 5 (36.2%). The overall frequency of hypocalcemia was 44.2% (83/188), increasing significantly with advancing stage: 18.0% in stage 3, 34.3% in stage 4, and 64.7% in stage 5 (p for trend <0.001). Hypocalcemic patients were older (55.8 ± 13.1 vs. 51.4 ± 12.6 years, p=0.018) and showed strong associations with hyperphosphatemia (81.9% vs. 49.5%, p<0.001), elevated alkaline phosphatase (66.3% vs. 39.0%, p<0.001), secondary hyperparathyroidism (89.2% vs. 64.8%, p<0.001), and vitamin D deficiency (85.5% vs. 70.5%, p=0.014). In multivariable analysis, independent predictors included CKD stage 5 (vs. stage 3: adjusted OR 7.82, 95% CI 3.28–18.64, p<0.001), hyperphosphatemia (adjusted OR 4.15, 95% CI 2.01–8.57, p<0.001), and elevated alkaline phosphatase (adjusted OR 2.68, 95% CI 1.38–5.21, p=0.004). Conclusion: Hypocalcemia affects nearly half of non-dialysis CKD stages 3–5 patients in this Pakistani cohort, with markedly higher prevalence in advanced stages and strong links to CKD-MBD features. These findings highlight the need for routine calcium monitoring, early phosphate control, and targeted management to mitigate complications in resource-limited settings.
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